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Cost effectiveness of modalities of Palliative Biliary Drainage in Malignant Extrahepatic Biliary Obstruction
Journal article   Open access   Peer reviewed

Cost effectiveness of modalities of Palliative Biliary Drainage in Malignant Extrahepatic Biliary Obstruction

Abdullah Abbasi and Shyam Menon
Clinical and translational gastroenterology
07/06/2026
DOI: 10.14309/ctg.0000000000001062
PMID: 42407086
url
https://doi.org/10.14309/ctg.0000000000001062View
Published (Version of record) Open Access

Abstract

Biliary drainage in malignant extrahepatic distal bile duct obstruction (MBO) can be achieved with Endoscopic Retrograde Cholangiopancreatography (ERCP), Percutaneous Transhepatic Biliary Drainage (PTBD) or Endoscopic Ultrasound assisted choledochoduodenostomy (EUS-CDS). The aim of our study is to evaluate all these modalities in a cost-effective model. A patient level discrete time cycle Markov model was developed using United Kingdom's healthcare resource group (HRG) tariff costs. Health related quality of life (HRQoL) data was used to develop Quality adjusted life years (QALYs). Monte-Carlo deterministic analysis was performed. Probabilistic Sensitivity Analysis and deterministic analysis were performed. EUS-CDS was the most cost-effective modality for biliary drainage in MBO, (Cost £2,116 ($2,853.99) / Effectiveness 1.35) compared to ERCP (£2,349 ($3,168.25) / 1.33) and PTBD (£3,161 ($4,263.45) / 1.31). Microsimulation over 1,000 patient iterations confirmed that EUS-CDS had the highest net monetary benefit. EUS-CDS appears to be a cost-effective strategy for biliary drainage in malignant obstruction under a range of modelling assumptions, particularly in settings with adequate availability and expertise.

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